Baroreflex modulation to gradually change a physiological parameter

• US 8,626,282 B2
• Filed: 11/15/2012
• Issued: 01/07/2014
• Est. Priority Date: 12/24/2003
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Libbus, Imad, Spinelli, Julio C.
• Primary Examiner(s): Stoklosa, Joseph
• Application Number:
  US13/678,465
• Publication Number:
  US 20130079838A1
• Time in Patent Office: 418 Days
• Field of Search: 607117-118, 607/44, 607/42
• US Class Current: 607/2
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36146 specified by the stimulation parameters
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

An aspect of the present subject matter relates to a baroreflex stimulator. An embodiment of the stimulator includes a pulse generator to provide a baroreflex stimulation signal through an electrode, and a modulator. The modulator modulates the baroreflex stimulation signal to increase the baroreflex stimulation therapy by a predetermined rate of change to lower systemic blood pressure to a target pressure. Other aspects are provided herein.

Claims

1. A method, comprising:

sensing a physiological parameter;

using an implantable medical device, delivering neural stimulation that is effective in changing the sensed physiological parameter; and

using a programmed algorithm in the implantable medical device and using a programmed target value, a programmed period of time and sensed parameter values as inputs to the programmed algorithm, adjusting an intensity of the neural stimulation during the period of time to progressively change the sensed physiological parameter toward the programmed target value during the programmed period of time to reach the programmed target value after the programmed period of time.

2. The method of claim 1, wherein the physiological parameter includes a blood pressure parameter.

3. The method of claim 1, wherein the physiological parameter includes a surrogate parameter for blood pressure.

4. The method of claim 3, further comprising sensing activity and using the sensed activity as another input to the programmed algorithm, wherein adjusting intensity of the neural stimulation includes adjusting the intensity based on activity to account for activity while progressively changing the sensed physiological parameter toward the programmed target value during the programmed period of time to reach the programmed target value after the programmed period of time.

5. The method of claim 3, wherein adjusting intensity of the neural stimulation includes adjusting the intensity based on circadian rhythm to account for the circadian rhythm while progressively changing the sensed physiological parameter toward the programmed target value during the programmed period of time to reach the programmed target value after the programmed period of time.

6. The method of claim 1, further comprising determining cardiac output, wherein adjusting the intensity of the neural stimulation includes adjusting the intensity based on the cardiac output to account for cardiac output while progressively changing the sensed physiological parameter toward the programmed target value during the programmed period of time to reach the programmed target value after the programmed period of time.

7. The method of claim 1, wherein the physiological parameter includes a respiration parameter.

8. The method of claim 7, wherein the respiration parameter includes minute ventilation or tidal volume.

9. The method of claim 1, wherein using the programmed algorithm to increase the intensity of the neural stimulation includes using the programmed algorithm to determine a rate for changing the intensity of the neural stimulation as a function of the sensed physiological parameter and the programmed target value.

10. The method of claim 1, wherein using the programmed algorithm to adjust the intensity of the neural stimulation includes preventing a central nervous system from adapting to increased neural stimulation.

11. A method, comprising:

sensing a respiration parameter;

determining cardiac output; and

implementing a programmed algorithm in an implantable medical device to control an intensity of neural stimulation delivered by the implantable medical device to gradually change the sensed respiration parameter with time from a start time and over a period of time following the start time to reach a programmed target, wherein the programmed algorithm adjusts the intensity of the neural stimulation and determines the rate of change as a function of the sensed respiration parameter, the programmed target and the cardiac output.

12. The method of claim 11, further comprising:

receiving an event trigger to initiate a process performed by the implantable medical device to gradually change the sensed respiration parameter;

interrupting the programmed algorithm when the sensed respiration reaches the target; and

determining if cardiac output is not acceptable, and modifying the programmed algorithm if the cardiac output is not acceptable to modify how the sensed respiration parameter is gradually changed.

13. The method of claim 11, wherein the programmed algorithm adjusts the intensity of the neural stimulation to account for circadian rhythm changes to the respiration parameter while progressively changing the sensed respiration parameter toward the programmed target.

14. The method of claim 11, further comprising sensing activity, wherein the programmed algorithm adjusts the intensity of the neural stimulation to account for the sensed activity while progressively changing the sensed respiration parameter toward the programmed target.

15. An implantable medical device, comprising:

a neural stimulator configured to deliver neural stimulation that is effective in changing a physiological parameter; and

a programmed controller configured to use a programmed target value, a programmed period of time, and sensed values for the physiological parameter as inputs to adjust an intensity of the neural stimulation during the period of time to progressively change the sensed physiological parameter toward the target value during the period of time to reach the programmed target value after the period of time.

16. The device of claim 15, further comprising a respiration sensor configured to sense a respiration parameter, wherein the physiological parameter includes the respiration sensor, and wherein the programmed controller is configured to use the programmed target value, the programmed period of time, and sensed values for the respiration parameter as inputs to adjust the intensity of the neural stimulation during the period of time to progressively change the sensed respiration parameter toward the target value during the period of time to reach the programmed target value after the period of time.

17. The device of claim 16, further comprising an activity sensor configured to sense activity level, wherein the programmed controller is configured to use the programmed target value, the programmed period of time, the sensed activity level, and sensed values for the respiration parameter as inputs to adjust the intensity of the neural stimulation during the period of time to account for activity while progressively changing the sensed respiration parameter toward the target value during the period of time to reach the programmed target value after the period of time.

18. The device of claim 16, wherein the programmed controller is configured to use the programmed target value, the programmed period of time, a programmed circadian rhythm template, and sensed values for the respiration parameter as inputs to adjust the intensity of the neural stimulation during the period of time to account for circadian rhythm while progressively changing the sensed respiration parameter toward the target value during the period of time to reach the programmed target value after the period of time.

19. The device of claim 16, further comprising a cardiac output sensor configured to sense cardiac output, wherein the programmed controller is configured to use the programmed target value, the programmed period of time, the sensed cardiac output, and sensed values for the respiration parameter as inputs to adjust the intensity of the neural stimulation during the period of time to account for cardiac output while progressively changing the sensed respiration parameter toward the target value during the period of time to reach the programmed target value after the period of time.

20. The device of claim 16, further comprising a clock configured to sense a time of day and an activity sensor configured to sense activity level, wherein the programmed controller is configured to account for the time of day and the activity level when adjusting the intensity of the neural stimulation to progressively change the sensed respiration parameter toward the target value during the period of time to reach the programmed target value after the period of time.